(more than 3 per year) are more frequent andinjurious.
For older adults who live alone, be-coming incapacitated and unable to get helpimmediately after a fall is also a common ex-perience. In a population-based study, Gurleyand colleagues
showed that in people 65 orolder who lived alone, the annual risk of beingfound helpless or dead at home by paramedicsis 3.2%. Weakness or the inability to get up andfalls were the most frequently cited precipitat-ing causes of incapacitation among the sur-vivors found. Nevitt and colleagues
reported539 falls after a 1-year prospective cohort studyon 189 ambulatory adults over 60 years of agewho had fallen once in the previous year. Fiftypercent of the fallers reported being unable toget up without assistance in 41% of the falls.Even though most falls have limited physi-cal consequences and are not functionally lim-iting,
they can lead to a loss of confidence andthe development of a fear of falling.
Commu-nity-based studies of independently livingolder adults have estimated that 25–50% of thispopulation have a fear of falling.
Fear of falling is a complex problem that can affect not just people who have fallen but also those whohave not. It increases with age, especially forthose who have had a fall in the past, and canalso lead to other negative outcomes, such asfunctional decline,
and decreased social contact.
Fear of falling has generated an industrymarketing automatic alarm-and-notificationsystems, commonly called personal emergencyresponse systems (PERS). PERS take manyforms, but the common thread is that the per-son at risk is equipped with an electronic de-vice carried or worn that, after being activated by the user, can inform a central system whena potentially adverse event occurs. Studies onthe use of PERS as a substitute for in-home su-pervision have found them to be cost-effective inthe context of hospital utilization rates and in-stitutionalization among community-dwellingelders.
Moreover, they offer a sense of security to family members caring for olderadults living alone and can alleviate their per-ceived burden.
Although PERS constituteimportant technological adjuncts to home care,they require the direct intervention of the per-son to activate the signal indicating an emer-gency. In the case of a fall-related emergency,this can be impractical when the person is ly-ing unconscious on the floor,
is unable to ac-tivate the button, or suffers from cognitive im-pairments. Reliable automated fall detection,coupled with an appropriate help responsefrom a community alarm center, can increaseconfidence in people with fear of falling, pro-mote active safe living for elders, and reducecomplications from falls.
Over the years,many technological approaches have been de-veloped to address this issue. They can be di-vided into two groups: environmental motionsensing based on “exosensors” positioned inthe individual’s home
and user-based mo-tion sensing with “endosensors” worn by theindividual. Environmental sensing uses algo-rithms to determine whether, according to in-puts from image sensors (cameras, single-ele-ment passive infrared sensors, pyroelectricinfrared sensor arrays) positioned in the envi-ronment, a fall has occurred in a known vol-ume.Numerous groups have studied fall detec-tion employing user-based motion sensingwith wearable devices.
Typically, mo-tion sensors embedded with a microcontrollerrecord the kinematics of body segments anddetect fall events from the recorded signals us-ing expert systems. Once a fall event is de-tected, an alarm is sent through a radiofre-quency link with a communication deviceconnected to a PERS. Variations on this designhave appeared in various commercial formsand/or are still under development. All of these designs use similar motion sensors(mostly 2D or 3D accelerometers) but detect fallevents differently, using (1) kinematic signalsrecorded at different locations on the body(waist, neck, midtrunk, arm); or (2) different in-puts and processing approaches from therecorded signals (impact, energy of the impact,change in position, etc.); or (3) different expertsystems (Boolean logic, fuzzy logic, neuralnets) to infer from these inputs that a fall hasoccurred. Although numerous designs and sys-tems for automated fall detection based on mo-tion sensing with wearable devices have beenproposed and in some case commercialized,published experimental data on their perfor-mance in real life or under laboratory condi-
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